Validation of the Society for Vascular Surgery Appropriate Use Criteria for Management of Intermittent Claudication
Recommended Citation
Mavilian C, Vega A, Alabi O, Arya S, Brooke BS, Chester C, Conte MS, Fereydooni A, George EL, Iannuzzi J, Kabbani LS, Lee MH, Mize B, Nguyen TM, Tiu M, Woo K, O’Banion L. Validation of the Society for Vascular Surgery Appropriate Use Criteria for Management of Intermittent Claudication. J Vasc Surg 2025; 82:e85-e86.
Document Type
Conference Proceeding
Publication Date
9-1-2025
Publication Title
J Vasc Surg
Abstract
Objective: To perform a multi-institutional retrospective validation of the Society for Vascular Surgery appropriate use criteria (AUC) for the management of intermittent claudication (IC). Methods: A retrospective review of patients treated for IC from 2005 to 2024 was performed across seven institutions. Inclusion criteria followed AUC assumptions and all definitions aligned with AUC. All treated limbs were rated as appropriate (benefit outweighs risk, B>R), indeterminate (IND) or inappropriate (risk outweighs benefit, R>B) per AUC by two authors, who resolved discrepancies through discussion. Analysis was performed on the patient level. If one limb was rated as R>B, the patient was rated as R>B. B>R and IND were grouped together (B>R/IND). Results: Among 333 patients, mean age was 69, majority male with typical comorbidities (Table). Mean follow-up was 4 years. Most had moderate lifestyle limitations, were low surgical risk, with short (<2 block) walking distance (Table). Femoropopliteal (FP, 47%) and aortoiliac (AI, 36%) were most commonly affected. There were 89 patients (27%) who received exercise therapy (ET) alone. Revascularization was performed in 217 (65%), of whom 142 (65%) were on optimal medical therapy at intervention, 54 (25%) received ET, and 79 (36%) underwent bilateral revascularization. Most interventions were AI (40%) or FP (42%) and endovascular (71%). Overall, 223 patients were categorized as B>R/IND and 110 as R>B. Among those who underwent revascularization, 110 (51%) were R>B and 107 (49%) B>R/IND. R>B patients had higher rates of symptom recurrence (58% vs 45%; P =.04), reintervention (45% vs 34%; P =.05), minor amputation (AMP) (8% vs 2%; P =.01), major AMP (8% vs 0; P <.001) and any AMP (14% vs 2%; P <.001). Conclusions: In this retrospective multi-institutional cohort, patients with IC who were treated inappropriately (R>B) per Society for Vascular Surgery AUC experienced significantly worse outcomes compared with those who received appropriate/indeterminate (B>R/IND) treatment. [Formula presented]
Volume
82
First Page
e85
Last Page
e86
